Clipless and Athermal Pedicle Control with Selective Suturing Technique Proceeding with Neurovascular Bundle Preservation during Robot Assisted Radical Prostatectomy

Mustafa Bilal TUNA; Tünkut DOĞANCA; İlter TÜFEK; Can ÖBEK; Ali Rıza KURAL

Makale detayları

Clipless and Athermal Pedicle Control with Selective Suturing Technique Proceeding with Neurovascular Bundle Preservation during Robot Assisted Radical Prostatectomy

Yazarlar:

Mustafa Bilal TUNA | Tünkut DOĞANCA | İlter TÜFEK | Can ÖBEK | Ali Rıza KURAL

Yayıncı:

Endourology Association

Ana Başlıklar:

Hastalıklar

Dergi:

Endourology Bulletin 2020 Vol.12 Issue 1, pp.1-8

Belge Tipi:

Makale

Yayın Tarihi:

1/2020

Belge Dili:

İngilizce

Document ID (Org No.):

2000409260

eISSN:

2148-0532

Özet:

 


Aim: During robot assisted radical prostatectomy, pedicle control can be accomplished by surgical clips and/or using

different energy sources. Migration of surgical clips can cause bladder neck contracture and bladder stone formation.

On the other hand;using different energy sources during pedicle division may cause thermal injury of the nerves which are critical for

recovery of potency. In order to obviate this situation; we describe clipless and athermal pedicle control with selective

suturing technique proceeding with neurovascular bundle preservation during robot assisted radical prostatectomy.

Matherials and Methods: Robot assisted radical prostatectomy (RARP) is performed via transperitoneal route in

antegrade fashion. After bladder neck incision, prostatic pedicle is divided. First right prostatic pedicle is selectively

freed and cut. Bleeding is controlled by a running V-Loc suture. Then neurovascular bundle is gently separated from

the prostatic capsule starting at the basis and proceeding towards the apex. The same procedure is performed for

the left prostatic pedicle. Following prostatectomy superficial bleeders are meticulously controlled by separate 5-0

polyfilament sutures. Between March 2018 and May 2019 this technique was performed in 29 patients. Bilateral nerve

sparing procedure was carried out in all cases.

Result: Mean preoperative PSA was 8.1±2.1 ng/ml, mean patient age was 60.8±6.5 and mean follow-up was 13.6±9.9

months. Mean console time, intraoperative blood loss and prostatectomy specimen weight were 201±45 min,

237±97 ml. and 59±29 gr., respectively. Complications were assessed according to the Clavien-Dindo classification.

Clavien Grade 2, 3a and 3b complications were encountered in 1, 2 and 1 patients, respectively. Surgical margins were

positive in 5 patients (17.2%). At post-operative first month 28 of 29 patients were continent. Potency rate was 66%

with PDE5 inhibitors.

Conclusion: Clipless control of pedicles during RARP(Robot assisted radical prostatectomy) seems to be feasible


without compromising intraoperative blood loss.

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Makale detayları

Clipless and Athermal Pedicle Control with Selective Suturing Technique Proceeding with Neurovascular Bundle Preservation during Robot Assisted Radical Prostatectomy

Yazarlar: Mustafa Bilal TUNA | Tünkut DOĞANCA | İlter TÜFEK | Can ÖBEK | Ali Rıza KURAL

Yayıncı: Endourology Association

Ana Başlıklar: Hastalıklar

Dergi: Endourology Bulletin 2020 Vol.12 Issue 1, pp.1-8

Belge Tipi: Makale

Yayın Tarihi: 1/2020

Belge Dili: İngilizce

Document ID (Org No.): 2000409260

eISSN: 2148-0532

Sayı

Yazarlar:

Mustafa Bilal TUNA | Tünkut DOĞANCA | İlter TÜFEK | Can ÖBEK | Ali Rıza KURAL

Yayıncı:

Endourology Association

Ana Başlıklar:

Hastalıklar

Dergi:

Endourology Bulletin 2020 Vol.12 Issue 1, pp.1-8

Belge Tipi:

Makale

Yayın Tarihi:

1/2020

Belge Dili:

İngilizce

Document ID (Org No.):

2000409260

eISSN:

2148-0532